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nebrhahe53

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Joined
Jun 13, 2014
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1,017
Reason
PALS
Diagnosis
06/2014
Country
US
State
Tx
City
Austin
I have a question about Medicare. I never thought it was so complicated-part A part B part D supplemental etc. For those of us with ALS, which parts of Medicare are best to get-obviously the drug costs for riluzole are important too. Any suggestions? Not to mention durable medical equipment.
 
If you can speak with your local ALS association they can give great advise. Fo me I chose the basic drug plan because I don't take riluzole it's very expensive and you hit your max quickly. For my supplemental I went with part G the cost with Aetna is 177.00 there is a 147.00 yearly deductible after that they pick up remainder of what Medicare does not pay. That includes the deductible for Medicare and the 20% out of pocket. Part F was very expensive but they pick up everything with no deductible. When I got PWC my cost was nothing otherwise my out of pocket could have been up to 8000.00 a big difference. This month I am getting my eye gaze dynovox computer which now is considered rental durable medical equipment my cost will still be nothing. Everyone has different needs and budget. And it does take some good research in choosing what's best for you. Hope this helps a little. Good luck.

Patrick
 
Medicare A is free to those on Social Security and covers hospitalization, skilled nursing home, hospice.
Medicare B costs $100 a month and covers doctors costs and DME.
Typically, Medicare covers 80% of the cost of a medical event, and you would be responsible for 20%. So for this reason, many people have a Medicare Supplement plan, which covers the remaining 20%.
Call up Social Security. They run Medicare.
 
Dme= durable medical equipment
 
Patrick & Atsugi have given you good advice. If you are not financially strapped, a combination of regular Medicare (Parts A & B) and a supplement (such as those endorsed by AARP and issued by United Health Care) may provide the best coverage for you. There are several plans, depending on what you can afford. The supplements may or may not include Part D, prescription drug coverage.

For those of us who are financially limited, a Medicare Advantage Plan may still be the best option, although I think the government is trying to phase them out. Medicare Advantage Plans are issued by private insurers and follow Medicare guidelines, but usually pay better than original Medicare. Most have an annual out-of-pocket maximum. Social Security sends the money withheld from a person's monthly Social Security check ($104.90 for 2014) to the private insurer to be applied to the monthly health ins. premium. Most of these plans include Part D. Plans can be compared on line at Medicare.gov. Be sure to have a list of all prescription medications handy before visiting the site, as you will need to enter all of them to get accurate cost information. Be sure to look at co-pay amounts, deductibles, and payment percentages for durable medical equipment as well as annual out-of-pocket limits. The better plans require a monthly premium payment in addition to the $104.90 from Social Security but are usually still less costly than original Medicare plus a supplement.

Good Luck!
 
I found that AARP was the most expensive and only offered United Health Care. The cost was over 400.00 a month. So shop around
 
Again, you can search on the MC site and get all the options, including OOP max. It is different by area. You cannot generalize to say UHC or any single payor is better.

UHC, btw, pays AARP for the "endorsement." It carries no particular meaning. I have been insured by UHC and have nothing against them. But large national plans are not always best in the MA space.

Also, one clarification -- though Advantage plans have to at least offer Medicare benefits, they often offer more, beyond reimbursing more. Read carefully. Note also that hospice benefits are only paid by traditional Medicare.

Also, look at local reviews/social media/national ratings and it is usually evident what payor(s) to avoid in your area. Also look at size of the network and who is in it. You can view/download a provider directory before making a decision. If it is a narrow network and has your primary doc(s), you might think, this is fine. But imagine that doc moves to Tibet and look at the depth/breadth of alternatives as well.
 
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